Rates of early-onset gastrointestinal cancers, beyond just colorectal cancer, are rising among people younger than age 50, according to experts from Dana-Farber Cancer Institute. Researchers from Dana-Farber published a literature review in the British Journal of Surgery showing that cases of newly diagnosed early-onset gastrointestinal cancers have risen by 14.8% between 2010 and 2019.
“Early-onset colorectal cancer has received attention because it was one of the first gastrointestinal cancers to be identified as having a significant shift in the demographic profile of the disease, and because it is the most common early-onset gastrointestinal cancer. Historically, colorectal cancer was primarily diagnosed in adults in their 60s and 70s, but in the 1990s a rising incidence in younger populations was first reported,” stated senior study author Kimmie Ng, MD, MPH, Director of the Young-Onset Colorectal Cancer Center at Dana-Farber. “This study takes a wider view and shows that other gastrointestinal cancers are also rapidly rising in young people, including pancreatic cancer, esophageal and gastric cancer, and other rare gastrointestinal cancers.”
Study Findings
The study authors conducted a comprehensive narrative review of literature revolving around early-onset colorectal, esophageal and gastric, and pancreatic cancers, as well as less common gastrointestinal cancers, including appendiceal, biliary, and neuroendocrine cancers. They assessed epidemiologic trends, risk factors, clinical and molecular characteristics, germline and somatic genetic features, and outcomes for these early-onset diseases.
The literature review found that the rise in early-onset incidence disproportionately affected Black, Hispanic, and Indigenous populations as well as women. Additionally, although cases were numerically highest among patients in the oldest age group studied (40–49 years), increases were statistically highest among the younger groups; these results aligned with recent data from the Centers for Disease Control and Prevention showing that rates for colorectal cancer among patients aged 15 to 19 have more than tripled and more than doubled for patients aged 20 to 24. These younger patients also tended to present with more aggressive disease features and require more intensive treatments than older patients. Most cases occurred sporadically, but some showed more germline pathogenic variants than average-onset gastrointestinal cancers.
Significance and Public Health Steps
The study authors pointed to a number of modifiable risk factors that could be associated with an increased risk of early-onset gastrointestinal cancers, including obesity, a Western-pattern diet, non–alcoholic fatty liver disease, smoking, and alcohol use. “Lifestyle factors such as obesity, a Western-pattern diet including a lot of processed foods, and a sedentary lifestyle are likely contributing to a lot of early-onset cases,” said co–first author Catherine O’Connor, a medical student at Harvard Medical School. They also recommended sharing a family history of diseases with loved ones for greater shared knowledge of increased familial risks.
“More research is required to fully understand if there are biological differences between early- and average-onset disease, and if treatment differences are warranted,” said co–first author Sara Char, MD, a medical oncology fellow at Dana-Farber. “We need representation and diversity in the epidemiologic studies and other research that we conduct, so that we’re taking a holistic view of these diseases across a diverse population.”
“We need to be thinking not only about the risk factors for these diseases but also how to screen, diagnose, and treat young people with these cancers,” said Dr. Ng. They urged that a multidisciplinary, equity-based approach would be necessary to gain a broader understanding of the underlying etiologies of these early-onset gastrointestinal cancers and work toward improved screening and support for these patients.
Disclosure: For full disclosures of the study authors, visit academic.oup.com.
